Method of monitoring medical item inventory

ABSTRACT

A medical item inventory system includes a plurality of different types of stored medical items. The system can track a quantity of a medicinal substance type removed from its storage location, including the quantity used and the quantity returned to storage. The system can monitor the medical item inventory in real time to automatically determine a low supply of a particular medical item type. In response to a determination of a low supply of a particular medical item type, the system automatically electronically places a purchase order to a supplier of the particular medical item type. The purchase order includes the particular medical item type, a requested quantity, and a requested delivery date. The requested quantity and delivery date can both be calculated by the system based on a rate of use of the particular medical item type.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No. 09/014,076filed on Jan. 27, 1998, which is a divisional of U.S. application Ser.No. 08/361,783 filed on Dec. 16, 1994, and the disclosures of each ofthese applications are incorporated herein by reference.

TECHNICAL FIELD

This invention relates to inventory monitoring and dispensing devicesand systems. Particularly this invention relates to apparatus fordispensing and tracking an inventory of medical items used to treatpatients in a hospital, clinic or other healthcare setting.

BACKGROUND ART

The treatment of patients in hospitals and clinics usually involves thereceipt by the patient of medical items. These items may includeconsumable items such as medications. Medical treatment may also involveother disposable items such as dressings and bandages or other medicalequipment. Items implanted into the patient or used in conjunction withsurgical procedures may also be used and consumed during the course of apatient's medical treatment. Examples of such items include splints,catheters or guide wires which are normally used during cardiaccatheterization or angioplasty. To serve the needs of its patients, aclinic or hospital must always maintain sufficient stocks of these itemson hand. Further, as medical items are often expensive, the chargesassociated with their use must be accurately billed to the patient.

Currently most systems for tracking inventory and use of medicalequipment items in a hospital or clinic environment are manual systems.The persons responsible for maintaining an inventory of particular itemsmust monitor the use of the items in each storage location within thehospital and order additional supplies when it is noted that theavailable stocks are running low. Often personnel are only familiar withthe stocks available in a particular storage location and as a result,additional stocks may be ordered even though ample supplies areavailable elsewhere in the same facility.

Certain drugs used in the course of medical treatment are regulatednarcotics. Supplies of such drugs must be kept in secure cabinets. Itemsmay be dispensed from the secure cabinets only by two (2) authorizedusers accessing the material and certifying the manner in which it isused. The use of such narcotics also may require considerable paperworkwhich takes away valuable time that could be used for treating patients.

The recording of medical items so that the patient may be billed fortheir use in the course of treatment is also largely a manual operation.The fact of use by the patient must be recorded in the patient's chartfor later billing. In some cases items have peel-off labels that includea bar code that can be scanned and used for billing purposes. However,this still requires that the nurse or medical technician transfer thecorrect coding to the proper location for later billing.

Complications in billing become even greater when items are removed frominventory to accomplish a planned surgical procedure and then the itemsare not used. A patient may be charged for use of a particular itemwhich is removed from inventory in anticipation of surgery. If duringthe surgery the item is not needed, a corresponding credit must beissued when the item is returned to stock. All of these activities taketime away from persons who could otherwise devote their time to thetreatment of patients. Such tracking and billing practices are alsoprone to inaccuracies which may cause the hospital or clinic to losemoney or which may result in over billing of the patient.

Thus there exists a need for an apparatus and system for monitoring anddispensing medical items in hospital or clinic environments that canmore accurately monitor inventories, dispense medical items andcorrelate the use of medical items with the patient whose treatment hasincluded their use.

DISCLOSURE OF INVENTION

It is an object of the present invention to provide a system formonitoring an inventory of medical use items to provide an indication ofwhat items have been used.

It is a further object of the present invention to provide a system formonitoring the use of medical use items so that supplies may bereplenished before depletion.

It is a further object of the present invention to provide a system formonitoring an inventory of medical use items that monitors a pluralityof items in real time.

It is a further object of the present invention to provide a system formonitoring an inventory of medical use items that requires theprocessing of no paper forms.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that indicates the patientwhose treatment has involved the medical use items.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that can be used to indicatethe technician or physician who has used such medical use items.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that provides for creditingof a patient's account upon return of an unused item to inventory.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that is used to store anddispense restricted items in a secure manner.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that can guide a user toselect the items that will be used in a particular medical procedure.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that may be used to trackand dispense a wide variety of various items and to record their use ina clinical or hospital environment.

Further objects of the present invention will be made apparent in thefollowing Best Modes for Carrying Out Invention and the appended claims.

The foregoing objects are accomplished in a preferred embodiment of theinvention by a system for monitoring and dispensing medical items in aclinical or hospital environment. This system includes a plurality ofitem storage locations. A particular type of medical item may be storedin each location. For example, one type of medical item may include aparticular type of catheter. Another may be a particular type ofmedication packaged in a particular dosage. Each location in the systemincludes at least one unit of the particular type of medical item.

A sensor is positioned adjacent to each location. A sensor isparticularly adapted to sense the addition or subtraction of a unit ofthe particular type of medical item that is stored in the location. As aresult, each time a unit of the particular item is added or removed fromstorage in the location, the sensor senses this and generates a signal.

A counter is connected to each sensor and records the number of unitsadded or removed from each location. The counter holds a count of thechange in the number of units at the location since the last time thecounter was read.

The counters associated with each location are connected to at least oneprocessor and at least one memory or data store. The data store includesa total of the number of items that are located in storage at thelocation. Periodically, the processor polls each of the counters andreads the change in the number of units stored therein. Thereafter theprocessor is operative to update the total number stored in the memoryto reflect the number of items currently stored at the location.

Embodiments of the invention include a data terminal which includes auser interface and which terminal is connected to the processing systemand the counters. The data store includes records concerning patients,procedures, authorized users of the system and each of the productsstored in each of the locations, including pricing information. Theuser, such as a technician or nurse, uses the interface of the dataterminal to identify the particular patient who is to receive themedical items taken by the user. Upon removal of the items from thestorage locations, the use of such items is recorded in the patientrecord in the data store so that the patient's chart may beautomatically updated and the item charged. In addition, a user usingthe data terminal may review information in the data store concerningprocedures and physicians to determine what medical items are requiredby a physician to conduct a procedure and may remove such items fordelivery to an operating room.

In other embodiments, controlled substances such as narcotics, may bedispensed using the system from a dispenser mechanism or an electroniclock drawer. In such embodiments, the user is required to identifyhimself at the display terminal. This information is processed andcompared to authorized user records in the data store to verify that theuser is an authorized user. In some embodiments the identifyinginformation on the user may be placed on an encoded object such as acard and the user may be assigned a personal identification number (PIN)that is memorized by the user. The data terminal includes a reader forreading the coded object and for receiving the user's PIN number whichhas a predetermined relationship to the data on the encoded object. Theproper input of the PIN with the corresponding user's coded objectverifies that a proper user is requesting to gain access to the items.For some strictly controlled substances two (2) authorized users may berequired to input their coded objects and PIN numbers in order to gainaccess to the controlled items.

As with the previously described embodiment, once the authorized userhas provided the necessary identification, the processor operates tocause the desired substance to be dispensed or made accessible to theuser. The user is also required to input the corresponding patient dataso that the patient's chart and billing may be updated.

In some embodiments of the invention, the system may interface withother computer systems such as the admission-discharge-transfer (ADT)computer system that the hospital uses to track patients. This is acomputer system which is used in a hospital or clinic to track patientlocation and activity. In addition, the system of the present inventionmay also be connected to the hospital information system (HIS) which isthe record storage facility of the hospital which maintains computerizedrecords concerning patients. As a result, patient activity, recordkeeping, and billing may be automated through the system of the presentinvention, along with inventory monitoring. The system of the presentinvention may also be used to produce a wide variety of reports from thedata store related to patients, authorized users, physicians and varioustypes of items used in inventory. Such a system may also be integratedwith an automatic ordering system so as to transfer supplies from onelocation to another where they are needed and/or to automatically placeorders for additional supplies with vendors when supply levels reach alimit.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a side cross sectional view of an inventory monitoringapparatus called a hook register used in the system of the presentinvention.

FIG. 2 is a front cross sectional view of the hook register shown inFIG. 1.

FIG. 3 similar to FIG. 1 depicting a medical item being removed from thehook register.

FIG. 4 is a partial cut-away top plan view of a further inventorymonitoring apparatus of the present invention called a box register.

FIG. 5 is a side elevation view of the box register shown in FIG. 4 asseen along line v-v of FIG. 4.

FIG. 6 is an enlarged view of the circled portion VI shown in FIG. 5.

FIG. 7 is a side view of a lever used in the box register shown in FIGS.4 and 5.

FIG. 8 is a top plan view of the lever shown in FIG. 7.

FIG. 9 is a front view of an alternative box register.

FIG. 10 is a partial side view of the box register along line 10-10 inFIG. 9.

FIG. 11 is an enlarged side view of a switch and lever of the boxregister shown in FIG. 9.

FIG. 12 is a front, partial cut away view of the lever and switch of thebox register shown in FIG. 9.

FIG. 13 is a schematic view of the system for monitoring and dispensingmedical items including the hook registers and box registers.

FIG. 14 is a top plan view of a dispenser mechanism for vials containingmedications.

FIG. 15 is a cut-away side view of the dispenser shown in FIG. 14 withthe gate members thereof in a first position.

FIG. 16 is a view similar to FIG. 15 with the gate members of thedispenser in a second position.

FIG. 17 is a side view similar to FIG. 16 with the gate members in athird position wherein a vial is dispensed from the mechanism.

FIG. 18 is a cross sectional view corresponding to the dispenser asshown in FIG. 15.

FIG. 19 is a side view of the dispenser mechanism corresponding to FIG.16.

FIG. 20 is a side view of the dispenser mechanism corresponding to FIG.17.

FIG. 21 is a side view of the dispenser mechanism and gate members inthe positions shown in FIG. 15.

FIG. 22 is a side view corresponding to FIG. 21 including hidden edgelines.

FIG. 23 is a side view of the dispenser mechanism with the gate membersin the positions shown in FIG. 16.

FIG. 24 is a side view of the dispenser mechanism corresponding to FIG.23 including hidden edge lines.

FIG. 25 is a side view of the dispenser mechanism with the gate membersin the positions shown in FIG. 17.

FIG. 26 is a side view of the dispenser mechanism corresponding to FIG.25 including hidden edge lines.

FIG. 27 is a sectional side view of the dispenser mechanism shown inFIG. 14 located inside a medicine dispenser.

BEST MODES FOR CARRYING OUT INVENTION

Referring now to the drawings and particularly to FIGS. 1 and 2, thereis shown therein a first embodiment of an inventory monitoring apparatusof the present invention referred to as a hook register and generallydesignated by reference numeral 10. Apparatus 10 includes an elongatedhousing 12 including an upper wall 14, a lower wall 16, side walls 18and 20, a front wall 22 and a rear wall 24. Housing 12 may be formed ofany suitable durable material such as plastic or metal. A clip assembly26 or similar attachment mechanism is desirably carried by a flange 28of rear wall 24 whereby the housing may be detachably fastened to a railor similar support structure 30 affixed to a wall 32 or like surface. Aswill be discussed in greater detail hereafter, rail 30 may also carry acommunications bus 34 or other suitable means for electricallyconnecting the apparatus 10 to a similar apparatus and to a remotecomputer and data terminal.

An object support means is designated by reference numeral 36. Asillustrated, the object support may assume the form of an elongatedrigid or angled rod which may be suitably formed of metal or plastic. Ashorter leg 38 of the object support means is affixed such as bythreaded fasteners 40 to the rear wall 24 of housing 12. A longer leg 42of the object support means extends generally longitudinally of thehousing 12 and is capable of supporting a plurality of objects 44. Thus,according to the first embodiment, object support means 36 resembles anelongated peg or rod which suspends objects 44 from holes orperforations 46 provided therein (see FIG. 2). The longer leg 42 ofsupport means 36 also desirably is formed with a raised portion 42A toprevent the objects from unintentionally sliding off the object supportmeans.

It will be appreciated that hook register 10 finds beneficial usage witharticles or objects which are suitable for suspension and whoseinventory it is desirable to monitor. Typical items may include packagescontaining medical items such as drugs, medical equipment, supplies,including for example, catheters and guide wires for angioplasty orother medical items which should be strictly and accurately monitoredbecause of theft, safety, critical need or other concerns. For thisreason, the object support means may assume any form necessary ordesirable to support the objects supported thereby. That is, the objectsupport means may be configured as a rack, multiple hooks or pegs orsimilar cantilevered members, a tee bar or other such equivalentconstructions.

A switch actuating means 48 desirably configured as a pivotable lever ismounted generally at its midpoint to housing 12 by a pivot pin 50. Inthe preferred embodiment, a first end of lever 48 projects through anopening 52 in lower housing wall 16. It is also contemplated that lever48 may be adapted to project through an opening similar to opening 52and may be provided in any other wall of housing 12 so long as thosecomponents necessary for the proper functioning of the apparatus 10 arecorrespondingly repositioned to accommodate the desired orientation andoperation of lever.

A second end of lever 48 is connected to suitable biasing means 54 whichin the preferred embodiment is a spring. In the preferred embodiment,the biasing means is a tension spring, however in other embodimentsbiasing means such as torsion springs, compression springs, elastomericmeans or the like may be used. The biasing means normally biases thelever to a “inoperative” position in which the lever extends generallytraverse to the longer leg 42 of the object support means 36 of the hookregister as depicted in FIG. 1.

It is important that the first end of lever 48 sufficiently project fromhousing 12 whereby it may be contacted and displaced by a medical item44 which may be either added to or removed from the object supportmeans. To assure that the lever will interfere with the passage of anobject, either into or out of a location on the object support means, afirst end of lever 48 is provided with a notch 56. Notch 56 isconfigured to receive the longer leg 42 of the object support means 36therein. As a result, when a medical item is removed from its storagelocation on the object support means, the object contacts and thendisplaces the lever so as to rotate it outward. The object then passesthe lever and once this occurs the biasing means 54 returns the lever tothe inoperative position.

A printed circuit board 58 is mounted in the interior of housing 12.Apart from certain circuitry components specifically identified belowwhich are essential to provide an adequate appreciation of the operationof the hook register, it will be understood that circuit board 58includes printed circuitry and other circuitry components.

Electrical switch means are supported by and electrically connected tothe circuit board 58. During operation the switch means serve as part ofa sensor that generates signals indicative of the placement of objectsinto the storage location on object support means 36 or removal of suchobjects from the storage location. The preferred embodiment of the hookregister utilizes a pair of switch elements 60 and 62 as the electricalswitch means. In the preferred embodiment, the switch elements areHall-effect sensors which change states (off-to-on) when a magneticfield is detected within close proximity. Lever 48 carries a compactpermanent magnet 64 which serves as an actuator means. The magneticfield produced by magnet 64 is capable of being sensed by switches 60and 62 to affect changes in their status. The signals indicating changesin the status of the switches are detected by a signal processingcircuit 65 which converts the signals to an appropriate form to bereceived and counted by a microprocessor 66. The microprocessor 66 inthe hook register serves as a counter which stores a count therein aslater described.

Operation of the hook register 10 is graphically represented in FIG. 3.Specifically, the object 44, which is preferably a medical item, isshown at the instant in time when it has fully deflected the lever 48against the force of the biasing means 54 and has just passed the firstend of the lever. At this moment, the permanent magnet 64 is pivotedinto a substantially facing relationship with magnetic field detectorswitch 60. Switch 60 is triggered upon detection of the magnetic fieldin proximity to the switch element and generates a signal indicatingthat one object unit has been removed from the object support means 36.Once the medical item has passed off the object support means, thebiasing means returns the lever to the inoperative position.

Similarly when a medical item is placed on to the object support means36, the lever 48 is pivoted in an opposite direction. This causes thepermanent magnet to trigger the magnetic field detection switch element62. This generates a signal indicating that one object unit has beenadded to the storage location on the object support means. Although inthe preferred embodiment magnetic field detection switches are used,other suitable switches such as three-way toggle switches, photosensors, optical encoders, capacitive or inductance sensors and the likemay be employed as sensors to achieve and generate the additive andsubtractive article registration signals. Likewise, the switch actuatingmeans may assume forms other than a pivotable lever depending on thetype of medical item and storage location involved. For example, alinearly reciprocal lever, a flexible flap or noncontact type sensorsmay be used in other embodiments.

The microprocessor 66 receives through signal processing circuit 65 thesignals generated by switches 60 and 62. The microprocessor containssoftware programs which record and count the state of the switches eachtime a change is detected. The number and direction of the changes arecounted and stored as a count in the microprocessor. In addition, themicroprocessor includes a computer program that enables it to be resetupon receipt of signals from a remote location. In the preferredembodiment, the microprocessor also has stored therein a locationidentifying indicator that is representative of a number and or otherdata uniquely associated with the particular hook register. Each hookregister and other dispensing apparatus in the system of the preferredembodiment has a location identifying indicator associated therewith.

The electronic circuitry of the inventory monitoring apparatus also hasthe ability to communicate its count information to other components ofthe system of the present invention. In each hook register, theprocessor 66 is connected through a ribbon cable 68 which is connectedwith an electrical coupling 70. Coupling 70 electronically couples witha communication bus 34. In this manner, circuit board 58 is enabled toreceive power from a remote power source and is enabled to transmit andreceive data through communication bus 34.

The operation of the hook registers 10 in the inventory monitoring anddispensing system of the of the present invention is best shown withrespect to FIG. 13. Each of the hook registers is connected to the databus 34. Each of the hook registers is connected to the data bus 34,which is connected to a hook controller shown schematically as 72. Hookcontroller 72 includes a processor and a data store therein which areoperable to communicate with each of the hook registers 10. The hookcontroller 72 is operable to periodically poll each of the hookregisters 10 on the data bus. The hook controller reads and receives thecount information in each of the hook registers and stores it inconjunction with the location identifying information associated withthe particular hook register from which the count was received. Afterthe reading of the count information in the register and transmission ofthe data to the hook controller 72, the count information in themicroprocessor 66 may be erased so a new count can be started.Alternatively, the microprocessor 66 in the hook register may beprogrammed to store the count information and the time each such countwas generated for a period of time while generating new countinformation. This can be done to assure that usage of items from anyhook register can be recovered even in the event of the failure of ahook controller. While FIG. 13 shows only four (4) hook registersconnected to controller 72, it will be understood by those skilled inthe art that many more hook registers may be so connected on the databus.

As a result of polling each of the hook registers 10, the hookcontroller 72 has in its associated processor and data store the countof units taken or added in conjunction with the identifying informationassociated with each hook register. The hook controller 72 is connectedby a further data bus 74 to a data terminal 76. Of course other hookcontrollers and controllers connected to other types of registers mayalso be connected to data bus 74. The data bus 74 is used to transmitand receive information from the connected controllers to the dataterminal 76.

Data terminal 76 includes a display screen 78 which serves as a dataoutput device. In the preferred embodiment, screen 78 is a “touchscreen” of the type known in the prior art wherein a user may input databy placing a finger adjacent to icons displayed on the screen. Sensorsoverlying the screen sense the position of the finger and convert it toinput data. As a result, touch screen 78 serves as a graphical userinterface which includes a data input device as well as a data outputdevice. Data terminal 76 in the preferred embodiment further includes acard reader 80. Card reader 80 may be used to read data encoded on amagnetic stripe of a user's identification card. Of course in otherembodiments of the invention other equivalent reader means for readingcoded objects or for reading a user's fingerprints or retina pattern maybe used depending on the level of security desired.

In the operation of the preferred embodiment of the invention, a medicaltechnician who wishes to operate the system and remove medical itemsfrom the hook registers 10 operates the display terminal. The terminalscreen outputs a visual prompt for the user to identify himself orherself to the system by input of identifying data. In certainembodiments, the identification may be accomplished by the userinputting an identification number assigned to the user by touching theappropriate numbers on a graphical keypad presented on the screen of thedisplay terminal. In other embodiments, the user may be requested toswipe their card in the card reader so that the magnetic stripe thereonmay identify the user to the terminal. In embodiments where highsecurity is required, a user may be requested to input both their cardand a personnel identification number (PIN) into the display terminal.The PIN has a predetermined relationship to the data on the card, andthe data terminal may be operated further only if a proper card and PINare input.

When a user enters their identifying information at the displayterminal, the display terminal communicates through a local area network(LAN) 82 to a remote computer 84 which includes a processor and a datastore therein. Computer 84 has preferably greater and faster processingcapabilities and more memory than a display terminal. The computer 84has stored therein information records associated with authorized users,and if the data input by the user at the display terminal corresponds toa record for an authorized user, then the display terminal will enablethe user to operate the system. In alternative embodiments of thesystem, one or more display terminals may have the additional processingcapabilities and the additional memory to perform the functions ofcomputer 84. In such cases the functions performed by the computer 84may be distributed among the display terminals.

Upon further use of the display terminal, the user may access certaininformation about patients, procedures or physicians which is stored inrecords in the data store of the computer 84. In the preferredembodiment, the stored records include information about patients. Theuser may select a particular patient at the display terminal. This ispreferably done by the user scrolling through a displayed list ofpatient names using “keys” presented graphically on the touch screen.However, other input devices for selecting a patient name may also beused. Upon finding the desired patient name, the user designates thatpatient's record by touching the patient's name on the screen.Thereafter, the user may remove medical items from the hook registersthat are needed by that patient. When this occurs, the number of unitsof each item removed from a particular hook register is stored as acount in the microprocessor in each hook register. This information isthen transferred to the hook controller 72 when the hook register ispolled, and is thereafter transferred to the data terminal 76 when thehook controller 72 is accessed through the data bus 74 by the dataterminal. As a result, data representative of both the patient and thelocation and number of units of medical items used for that patient isavailable in the data terminal.

When the user signs off the data terminal or selects another patient(indicating that the items for the prior patient have been taken), thedata terminal then transmits the information corresponding to the countsand location numbers of the items used for the selected patient throughthe LAN 82 to the data store in the computer 84. The computer 84functions to correlate the count and location numbers with a medicalitem record which indicates the types of items stored and the location.This provides an indication of what was used for the patient. Inaddition, the processor and memory in the computer 84 serve to updatethe record related to the patient to indicate that the items taken wereused for the patient so that the patient may be charged therefore. Thelocation records related to medical items preferably includes or may bereferenced to pricing information so that patient may be automaticallybilled. In addition, the computer 84 also updates its records concerningthe number of medical items remaining in storage in each location.

The computer 84 is operable in the preferred embodiment to maintain acontinuous real time record of how many units of medical items arestored in each of the locations. If the number remaining in any locationhas reached a lower limit, the computer 84 is programmed to provide awarning of the need to replenish the supplies at that location to anadministrator terminal or workstation 86. The administrator'sworkstation 86 is also a computer with a processor and data store and isconnected through the LAN. It has input devices such as the keyboard andmouse shown and an output device such as the screen shown. The terminal86 may also have other input and output means such as a touch screen,spoken word recognition, audio output or signal outputs connected toprinters or other devices. Of course, the need to replenish the suppliesmay be indicated on the screen at the administrator's workstation or inother output locations including the data terminals in the area wherethe hook registers need to be replenished.

In other embodiments, the data terminal may be used to help medicaltechnicians or nurses select medical items for patients. The computer 84also preferably includes records related to medical procedures as wellas physicians in its data store. This information may be accessed at thedisplay terminal by the medical technician or nurse who is obtainingsupplies for use in such a procedure. By accessing the stored datarecords related to the procedure, the technician can read a record whichincludes information such as the items that are normally used in such aprocedure. As a result, the technician may note these items and mayremove them from the hook registers while viewing the procedure recordto ensure that everything normally needed is transferred to theoperating room. In addition, the procedure records may be accessed inconnection with a physician record related to a physician who willperform the procedure. Such records may include additional medical itemsthat the particular physician requires to have present in an operatingroom when conducting a particular procedure. This may include additionalmedical items or particular types of medical items that the physicianprefers. It may also include convenience information such as theparticular type of music the physician prefers to have played in theoperating room during a procedure or other items that the particularphysician prefers to have available.

In other embodiments of the invention, computer 84 may be programmed tohave in its data store, and may provide in response to a request at adisplay terminal, a schedule of procedures in a particular hospitaloperating theater. This enables the medical technician or nurseparticipating in the procedure to locate the patient scheduled for aprocedure using the display terminal, and to access therewith therecords related to the physician and the medical items that will beneeded for the procedure. As a result, the technician or nurse may go tothe hook registers, obtain the necessary medical items and have themimmediately charged to the patient's account. If after the procedure notall of the items that were originally taken were used, the items may bereturned to inventory and credited to the patient's account. This isdone by the user identifying himself or herself to the display terminal76 and again identifying the patient to the system using the touchscreen 78 in the manner previously described. Replacing the unused itemsback on the hook registers 10 automatically creates a record that suchitems were returned and the patient's account will be credited in thecomputer 84.

Because of the large number of records that are stored in the data storeof the computer 84 and other connected computers, a large number ofreports related to inventory usage may be generated. This can beaccomplished by using database software such as Paradox® in computer 84.Alternatively, other relational database software may be used. Further,because the inventory at each location is monitored, messages requestingtransfers of inventory from areas where there are excess units to areaswhere there is a need can be automatically generated by the computer anddisplayed at the administrator's workstation. The computer 84 also keepsa running tally of what has been used by each patient as well as whathas been taken by each user and used by patients of each physician. Thisfurther allows monitoring of usage and allow potential abuses to beuncovered. The computer 84 is ideally programmed to look for patterns ofdispensing activity that have been programmed into the computer's memoryas potential abuses and to display a report thereof at theadministrator's workstation. Such potential abuses may include takingparticular items at abnormally frequent intervals. The computer 84 mayalso be programmed to provide reports from the database concerning whatparticular users have dispensed during a given time period and whatparticular physicians have used or prescribed for patients.

In the preferred embodiment of the system of the present invention, theadministrator's workstation 86 is used as the primary tool for themonitoring of inventory. The administrator's workstation is used toprogram the particular type of medical item stored in the location ateach of the hook register and in other types of registers in the system.This is done by creating a record for each location in the data store.The administrator's workstation is also used to set the level of theminimum acceptable number of units of each item at each location so thatan indication may be given of a need to replenish or transfer stock.This is programmed as a minimum for each location, and an indication isgiven when the minimum is reached. Further, the administrator'sworkstation preferably includes electronic ordering capability so thatwhen supplies of a particular item are reduced to a particular level, apurchase order to replenish the stock is sent automatically to themanufacturer. The ordering and source information is also optimally partof or referenced with the associated record with the item in the datastore. As a result, the administrator's workstation is programmed sothat when the quantity of an item on hand falls to a particular level,an order is communicated to the manufacturer of the needed item directlyover a telephone or other data line via a modem, indicatingelectronically the item needed, an order quantity and a date by whichthe items must be received. The order quantity data may be preprogrammedor may be calculated automatically by the computer using a program thatgenerates the order quantity based on rate of use. Likewise, thedelivery date may be a programmed time period after issuance of theorder, but may also be programmed to be a rush order if the “on hand”quantity has fallen to a second lower level or if the use rate is abovea programmed level.

The administrator's workstation may also be used to establish recordsfor authorized users and to set varying levels of security forauthorized users at different types of display terminals. Although inthe preferred embodiment, the administrator's workstation is the primarycontrol for the system of the present invention as shown in FIG. 13, thehospital's other computer systems including theadmission-discharge-transfer (ADT) system 88 and the hospitalinformation system (HIS) 90 are also connected to the local area network82. This enables the patient data in the computer 84 to be input andoutput to the ADT system 88 and records relating to patient activity orother activities to be received from or stored in the HIS, which istypically the long term data storage facility related to patients. Thesystem may also be connected to other computer systems in theinstitution such as systems in the pharmacy or dietary and foodservices. Each of these systems may contain multiple processors and datastores which transmit selected data to and from the LAN 82. This enablesthe exchange of data throughout the hospital's computers whichfacilitates both record keeping, patient billing and monitoring of itsinventory.

The hook registers 10 which are optimally constructed for supportinghanging items are only one type of dispensing device that can be usedwith the present invention. FIGS. 4 through 6 reflect a furtherembodiment of an inventory monitoring apparatus designated by thenumeral 110. Apparatus 110 is called a box register as it is optimallyadapted to include storage locations for holding boxes or box-likearticles. Box register 110 includes an elongated housing 112 includingan upper wall 115, a lower wall 116, end walls 118 and 120, a front wall122 and a rear wall 124. Like housing 12 of hook register 10, housing122 may be fabricated from any durable material such as plastic ormetal. Although not shown, it will be understood that a clip assemblysimilar to clip assembly 26 of FIGS. 1 and 2 or a similar attachmentmechanism may be used to detachably fasten the housing to a wall.Alternatively, apparatus 110 may rest on a level shelf, tabletop orreside in a cabinet. Each box register 110 is connected to acommunication bus 74 (see FIG. 13).

With regard to the box register, in this embodiment, an object supportmeans is represented by reference numeral 136 which support means mayassume the form of a receptacle having at least one or preferably aplurality of compartments or object storage sites 138 which arelocations wherein medical items may be stored. In this embodiment,object support means 136 is constructed as a multiple compartment, heavygage, stiff metal wire rack including a pair of upright truss-like endwalls 139, a plurality of spaced apart storage site divider walls 140situated between and generally parallel to the end walls 139 and aplurality of transverse members 141 affixed to the end walls 139 anddivider walls 140. The end walls 139 are desirably secured by suitablemechanical fastening means 142, such as nuts and bolts or the like tolower wall 116 (as shown) or any other wall of the housing 112.

As shown in the figures, the object support means 136 is adapted tosupport objects 144 of substantially uniform dimensions (one of which isshown in phantom in FIGS. 4 through 6) in a substantially uprightorientation. For example, objects 144 may be generally uniformly sizedrelatively thin boxes or similar packages which may contain variousdesignated types of medical products. The object support means asillustrated is thus capable of supporting an object on four sidesthereof, i.e. the bottom, back and both lateral sides of the object (seeFIGS. 4 and 5). In this fashion, an object 144 may be removed from theobject support means 136 by lifting it forward (to the right as shown inFIG. 5) and/or upward. The bases of the divider walls 140 are situatedat a lower elevation than the upper wall 114 of housing 12 (FIG. 5)whereby the objects 144 are caused to be tilted slightly rearwardly suchthat the back sides of the objects maintain contact with the rear of theobject support means 136.

Although the described embodiment of the object support means 136supports the objects 144 such as boxes in substantially upright orvertical position, the present invention also contemplates rackgeometries whereby objects may be supported substantially horizontally,at acute angles or in a staggered array incorporating one or moreangular support orientations. Further, the spacing between the dividerwalls 140 need not be uniform in which case storage sites 138 ofvariable dimensions may be provided in the same object support means136. Of course the object support means 136, like housing 112, may befabricated of metal or from any high strength substantially rigidplastic or other suitable material.

Box register 110 includes switch activating means 148. The switchactivating means 148 includes one or more levers pivotally mounted at150 (see FIG. 6) to housing 112 in a manner described hereafter. Thelevers 148 correspond in number to the number of compartments 138 whichare the storage locations provided in the object support means 136. Afirst end of each lever 148 projects from the housing 112 into arespective one of the storage sites 138 and a second end of each leverextends into the housing as most clearly seen in FIG. 6. The first endof each lever protrudes from the housing for a distance sufficient to becontacted and displaced by an object 144 when such object is added tothe object support means 136. Biasing means later discussed return thelevers to inoperative positions upon removal of an object from thecorresponding storage site.

Referring to FIGS. 4 and 6, as is the case with the hook registersdescribed above, the box registers likewise have printed circuit boardstherein designated 158 one of which is shown. Circuit boards 158 aremounted in the interior of housing 112. Circuit boards 158 includeprinted circuitry and other circuitry components which are notillustrated or described in detail except to the extent necessary for aproper understanding of the present invention.

Electrical sensor means are supported by and electrically connected tocircuit board 158. The sensor means generate signals indicative of theplacement of an object onto and the removal of an object from the objectsupport member 136. According to the preferred embodiment, the sensormeans comprises one or more discrete force actuatable switches 160 suchas snap-type internally resilient dome switches or other type electricalswitches. Switches 160 are spaced apart along the length of circuitboard 158 and correspond in number to the levers 148 whereby the secondend of each lever operates a separate switch.

The switches 160 generate real time counting signals indicative of thetotal inventory of objects 144 carried by the object support sites whichare occupied and those which are unoccupied at any instant in time. Thuswhen a lever 148 is caused to pivot in one direction by an object thatis placed into a storage location, the second end of the lever closesits respective switch 160. This is reflected by the solid line image oflever 148 depicted in FIGS. 5 and 6. Switch 160 in turn generates aregistration signal indicating that an object has been placed into thestorage location and at which storage site the object has been added.

Conversely, when an object is removed from the object support means, thebiasing force from the internal resilience of the dome switch 160returns the lever to its inoperative position as is reflected by thedash line image of lever 148 illustrated in FIG. 5 and 6 whereby theswitch is open. In this position, the switch generates a registrationsignal which reflects that an object has been removed from the storagelocation. Additionally, if mechanical switches other than dome type orother similar switches possessing internal resiliency are employed asthe electrical switch means, then biasing means such as springs orelastomeric means may be provided to assure that the switches changeelectrical condition upon removal of objects from the object supportmeans 136. Alternatively, certain switch types have built-in springswhich provide the biasing force. Although dome type switches are used inembodiments of the box registers, other suitable sensor means such astwo-way toggle switches, momentary contact switches, photo sensitiveswitches, capacitive or inductance sensors and the like may be employedto affect the generation of additive, subtractive and object locatingregistration symbols.

FIGS. 7 to 8 show on an enlarged scale a lever 148. The lever desirablyincludes a pair of opposed notches 161, 162 which generally separate thelever into its first and second ends and, in cooperation with matingslots provided in the front wall 122 of housing 112, establish thepivotal connection 150 of the lever relative to the housing. Further,each lever 148 is preferably provided with a downwardly sloping lip 163at the leading edge of its first end to facilitate insertion of theobjects 144 into the storage sites 138.

The signals indicating changes in the status of the switches 160 aretransmitted by wire or other acceptable signal conducting means 164whereupon they are detected by a signal processing circuit 165 whichconverts the signals to an appropriate form to be received and countedby a microprocessor 166. The microprocessor 166, like microprocessor 66of the hook registers 10 described above, contains software programswhich record the state of the switches each time a change is detected.The microprocessor 166 also counts and stores a count indicative of thenumber and direction of changes in state as they occur. Further, themicroprocessor 166 includes the unique location identifying indicatorassociated with each of the storage locations in which any changes inthe presence of a medical item have occurred. Alternatively, themicroprocessor 166 may keep track of the times such changes haveoccurred.

While not illustrated it will be appreciated that the hook and boxregisters are preferably remotely powered through the associated busconnections. In other embodiments they may be locally powered. Further,in other embodiments the registers may include LED or LCD displays onthe registers for indicating the powered condition of the particularregister or the fact of a change in the status of inventory items at thelocation. Of course suitable LED or LCD indicators may also be used forother purposes such as indicating the particular type of item to bestored, that the register is in a restocking mode, or that the amount ofinventory stored in the location has fallen below a critical level. Thisis accomplished by programming in computer 84, or programming in theother processors connected to LAN 82 to output such an indication undersuch conditions.

An alternative embodiment of a box register 110′ is shown in FIGS. 9through 12. Box register 110′ is similar to the previously described boxregister 110 except as expressly noted herein. The box register 110′includes a plurality of compartments 126 which are separated by dividerwalls 128. Each compartment has located therein a lever 130, which ismovable about a pivot 132 (see FIGS. 11 and 12). The lever includes anobject engaging leg 123 and a switch actuating leg 133. The leg 133 isengageable with an actuating projection 134 of a switch 135. The switch135 includes an internal spring which biases the actuating projectionoutward from the switch. The switch operates to change its electricalcondition when the actuating projection is depressed.

Objects or items such as boxes holding medical supplies are stored inthe compartments 126. The presence of an object in the compartmentengages the object engaging leg 123 and moves the associated lever 130to the position shown in phantom in FIG. 11. In this position lever 130is in abutting relation with a stop member 152 which bounds the rear ofthe compartment. The stop 152 prevents the object engaging leg of lever130 from being rotated rearward beyond the position shown in phantom.When object engaging leg 123 is in engagement with stop 152, switchactuating leg 133 depresses actuating projection 134 of switch 135resulting in the switch having a first electrical condition.

Upon removal of the box or other object from the compartment, actuatingprojection 134 moves outward in response to the biasing force of theinternal spring as the object disengages lever 130. Outward movement ofactuating projection 134 causes switch 135 to change its electricalcondition. As in the earlier described embodiment of the box registerthis change is noted in conjunction with the location information in thebox register's associated microprocessor, similar to microprocessor 166.

Although the box registers shown are a single tiered rack, the objectsupport means may comprise a multi-tiered rack or a plurality of rowsand/or columns of cubicles whereby each of the storage sites or cubiclesmay be appropriately fitted with a switch actuating means such as alever.

In the preferred form of the invention, the box registers are connectedthrough bus 74 with the display terminal 76. The display terminalperiodically reads the count information in the microprocessor 166associated with each of the box registers and receives changes in thecount information associated with each of the storage locations in thebox registers.

A user may operate display terminal 76 to indicate the appropriatepatient for which material taken from the box registers will be used inthe manner previously described with regard to the hook registers. Inaddition, the administrator's workstation is used in the setup of thesystem to assign the particular type of medical item to be stored ineach location in the box registers which is stored in a record incomputer 84. However, unlike the hook registers which may store asubstantial number of units of the particular type of medical item ineach location, a box register is adapted to store only one such item ineach location. Therefore, in some embodiments several adjacent locationsin the box register are designated for containing the same type ofmedical item.

As is also the case with the hook registers, a user of the system who isreplenishing inventory to the box registers may operate the displayterminal to so indicate using the touch screen data entry device that heor she is replenishing inventory. In this case, the records in computer84 will be updated to indicate the units of inventory added in each ofthe storage locations. No patient is credited for the items stocked inthe locations and a record in the data store concerning the number ofsuch items on hand but not yet placed for use in a location is alsoupdated. In alternative embodiments, a bar code is applied on thevarious items stored in the hook and box registers. A bar code reader orscanner shown schematically as 104 in FIG. 5 is positioned in the hookand box registers so that the code on the item is read as it is placedor removed from a location. The bar code scanner generates signals thatare interpreted by software for reading bar codes which runs in computer84 or another terminal in the LAN 82. A data store associated with thesoftware includes information which correlates each bar code identifierwith a particular medical item. This provides a check that the itemactually stored or taken is the type that is recorded as stored in thatlocation. If an error is made an alarm may be given, either at theregister, display terminal and/or the administrator's workstation.Alternatively, the bar code on the medical items may be used to “set up”the system, so that the system records the fact that a particularmedical item is stored in a particular location as a result of havingread the bar code thereon as the item is placed therein. This avoids theneed to program the Administrator's workstation with this information.The bar code scanner can be provided in addition to the indicator whichindicates an item is added or removed. Alternatively, the bar code maybe read as each item is removed from a location on a hook or boxregister and the use for the patient of the item recorded directly inresponse to reading the bar code signals and identifying the patient atthe display terminal.

The information included in the data store with respect to particularitems may also include a date by which perishable items must be used.The user stocking such items in the locations can input such informationusing the input device of the data terminal. Items having a limitedshelf life are preferably stored in the box registers where the “use by”date can be uniquely associated as part of the record for the only itemin the location.

The system can also be used with other types of devices that are used toindicate that an item has been taken for a patient. One such device is amanual input register where a nurse or other medical technician manuallyindicates that an item has been taken.

In one embodiment a manual register is structurally similar to boxregister 110′ except that it does not include compartments or levers.The actuating projections of the switches are connected to manuallyengageable buttons. The system is programmed so that the momentarychange in electrical condition of a switch resulting from depression ofa particular button represents the taking of one unit of a particularitem from storage. Preferably each button is labeled with indiciarepresentative of the item that it is associated with.

In the case of a manual register, the nurse or medical technician quesup the patient who will receive the items on the screen of the dataterminal and touches the screen to select that patient. The user pusheseach button on the manual register corresponding to the type of itemtaken. By pressing the button once for each unit of an item taken, datais stored in the microprocessor associated with the manual registerwhich is representative of the particular button location pushed and thecorresponding count associated with that button. This information iscorrelated with the patient record in the same manner as occurs with thehook registers and box registers.

The system of the present invention may also be used in conjunction withother types of dispensing devices. An example of such a device is anelectronic lock drawer 96. The electronic lock drawer may be used tostore narcotics or other articles, the use of which is highly restrictedand which are not suitable for storage in a hook or box type register ofthe type previously described. Alternatively, the electronic lock drawermay comprise a secure enclosure housing hook registers or box registersin its interior. The function of the electronic lock drawer is to holdthe restricted items and provide access thereto by opening a lockingmechanism of the unit only when a set of predetermined conditions aresatisfied.

In the preferred form of the invention the electronic lock drawer isconnected to and the opening thereof controlled through an adjacent dataterminal 98. Data terminal 98 is similar to data terminal 76. Dataterminal 98 is connected to the electronic lock drawer 96 and isoperable to unlock the lock thereto upon receipt of appropriate signalsfrom computer 84. Of course although only one electronic lock drawer isshown in connection with data terminal 98, additional electronic lockdrawers may be connected thereto.

In the preferred form of the invention, information about each type ofrestricted material housed in each electronic lock drawer is stored in arecord in the computer 84. To gain access to these materials a user mustfirst identify himself or herself to the data terminal in the mannerpreviously described. Preferably for highly restricted items, computer84 requires not only a user to input an identification card and PINnumber but also a second authorized user to input their coded card andPIN number. The purpose for requiring two (2) authorized users to bepresent to open the electronic lock drawer is so that the items removedand their disposition may be verified.

Preferably, the computer 84 has stored in the patient record,information about the medications that the patient has been authorizedto be given. As a result, the user may use the data terminal to selectthe patient name and to request the opening of the electronic lockdrawer so the user may take the medication for the patient. This is doneusing the touch screen of the data terminal as an input/output device.Thereafter, upon proper input of a further authorized user'sverification information, the electronic lock drawer will unlock inresponse to signals sent from the computer 84 to the data terminal 98and from the data terminal 98 to the lock drawer 96. Thereafter, theuser may remove the medication from the lock drawer in the presence ofthe verification user and reclose the unit. Upon the user inputting averification input to the data terminal that the medication has beentaken, the associated record of use and the charge therefore isautomatically added to the patient's account by the computer 84.

It does not matter if a medication that is stored in the electronic lockdrawer is not listed as one the patient is authorized to receive in thepatient's records in the computer 84, the user may still access theelectronic lock drawer. A user may input a request through the dataterminal for a listing of medications available. In response thecomputer 84 outputs to the data terminal a listing of the availablemedications and the dosages. The computer may also provide informationon the location of each medication. The user may then select aparticular type of medication and then input through the data terminal arequest for a listing of patients which again is provided from therecords in the data store of computer 84. By selecting the patient whois to receive the medication (and when appropriate providing thenecessary verification from a co-authorized user) the appropriateelectronic lock drawer will unlock and allow access to the medication.Upon verification input to the data terminal from the user that themedication has been removed, the computer will charge the patient'saccount therefore by updating the patient's record. Of course as is thecase with the other medical item storage locations previously described,computer 84 also operates to keep track of the inventory of variousitems inside the electronic lock drawer 96 to assure adequate stock. Thecomputer is also programmed to record the users and verification userswho have removed items from the electronic lock drawer and the types ofitems taken so that any shortages or patterns of abuse may beautomatically noted. Further, as discussed previously, data terminal 98may be used to access information in the computer concerning proceduresand physicians so that items in the electronic lock drawer 96 may betaken to an operating theater in advance of a surgical procedure.

Of course data terminal 98 may be used like data terminal 76 to credit apatient's account for items returned from inventory as well as toindicate replenishment of inventory in the electronic lock drawer. If anarcotic substance is to be returned the computer is programmed to havea verification user verify the returns. Returns are preferably made intospecial one way receptacles so that returned items can not be removed byunauthorized persons.

Another type of dispenser apparatus that may be used in the system ofthe present invention is the medicine dispenser 100 shown in FIG. 13.Medicine dispenser 100 is also used for dispensing medical items thatrequire high security such as narcotics. However, unlike electronic lockdrawer 96, medicine dispenser is operable to dispense only theparticular item requested and to restrict access to all the other itemshoused within the medicine dispenser. As shown in FIG. 13 the medicinedispenser is connected to a data terminal 102 that is similar to dataterminals 76 and 98. The operation of the data terminal 102 inconjunction with the medicine dispenser 100 is similar to the operationof data terminal 98 in cooperation with electronic lock drawer 96. Thedifference in the use of the medicine dispenser is that in response toselection of the particular medical item (and the co-user verificationif required) the medicine dispenser will provide to the user a singleunit dose of the particular medical item requested. As a result, theuser is not required to locate the item as is required with theelectronic lock drawer. In addition, the level of security required fordispense of medical items within the medicine dispenser can be varieddepending on the level of security required for the particular item. Asa result, for some items in the medicine dispenser 100 it may benecessary only to verify that the user is an authorized user. For othersubstances, only selected authorized users (and co-users) will be giventhe substance.

The interior of medicine dispenser 100 is shown schematically in FIG.27. Dispenser 100 encloses a plurality of dispenser magazines 168 onlyone of which is shown. Each magazine holds a plurality of vials 170which are held in inclined relation in the magazine. Each of the vialsin a particular magazine contains a predetermined dose of a substancesuch as a narcotic material that may be prescribed to a patient.Alternatively, other forms of cylindrically packaged medications oritems may be held in the magazines instead of vials. Medicine dispenser100 optimally houses a large number of magazines, each one holding vialswith a particular type of medicine. Each magazine 168 includes a vialdispensing mechanism later described in detail that releases vials inresponse to electrical signals one at a time from the lower end of themagazine. Released vials are guided on a chute 172 into a pocket 174 ina drawer 176. Drawer 176 may be a simple drawer or in alternativeembodiments may be controllably locked and unlocked by an electroniclock 178 shown schematically inside the medicine dispenser. Eachmagazine has a dispense verification sensor 179 associated therewith.Sensor 179 is operable to detect the actual dispense of a vial from amagazine. Sensor 179 may be an optical, mechanical or other suitablesensor type.

When medicines are requested at the display terminal 102, theappropriate vials from the magazines 168 are released and fall down thechute into the pocket 174. After the vials have been released and are inposition in the pocket, they may be taken. In alternative embodiments inwhich the drawer is controlled, the data terminal 102, in response tosignals from the computer 84 unlocks the electronic lock 178 and enablesthe drawer 176 to be pulled outwardly so that the vials in the pocketmay be taken.

Replenishment of the medicine dispenser 100 is accomplished by manuallyreplenishing the magazines and indicating that fact through the dataterminal. To accomplish this the medicine dispenser has to be opened.This is possible only under the most secure of circumstances and throughthe use of a mechanical locking system comparable to that which isconventionally used to secure narcotics. Normally, two keys are requiredto open the unit and each key is in the possession of a differentperson.

The operation of the vial dispensing mechanism is shown in greaterdetail in FIGS. 14 through FIGS. 26. FIG. 14 shows the vials 170 in themagazine 168. As shown in FIGS. 15 through 17 because the magazine istilted downward the vials tend to roll towards the front of the magazinetoward an opening 180. The vial adjacent the opening 180 contacts aguide 182 which is dog-legged in cross section. Guide 182 includes atapered face 184 which is engaged by the first vial 202 in the magazine.Guide 182 further includes an arm portion 186 that extendslongitudinally adjacent the vials. Arm portion 186 has attachedadjusting pins 188 which extend through the side walls 190 of themagazine. Adjusting pins 188 extend in angled slots 192 and may be fixedat selected positions therein using nuts mounted on the pins or othersuitable locking fasteners.

The movable mounting of the guide 182 enables the magazine toaccommodate different diameter vials by moving the guide in the slots192 to provide sufficient clearance for a vial to pass onto the guideadjacent opening 180 but not so much clearance so that the vial can fallout the opening without the actuation of the gate members as laterexplained. As best shown in FIGS. 18 through 20, a front gate 194 and aback gate 196 are mounted adjacent to opening 180. The front gate andback gate are mounted on a front gate shaft and a back gate shaft 198and 200 respectively.

As shown in FIG. 18 in the inoperative position of the gate membersfront gate 194 engages the underside of first vial 202 adjacent opening180. The end of front gate 94 engages vial 202 at a position outwardtowards opening 180 from a location on the surface of the vialdiametrically opposite where vial 202 engages tapered face 184 of guide182. As a result, the vial 202 is prevented from passing out throughopening 180. In this position any force applied to vial 202 (if it couldbe accessed) would tend to be resisted by compressive forces making itvery difficult for the vial to be manually removed. In the inoperativeposition of the magazine shown in FIG. 18 the back gate 196 has itsupper end extending parallel to a bottom wall 204 of the magazine. As aresult, in this position the back gate does not interfere with movementof the vials.

In the actuation sequence for dispensing a vial, the back gate rotatesin a clockwise direction to the position shown in FIG. 19. As it doesthis the back gate begins to move to a position blocking the vialimmediately behind vial 202 in the magazine from moving toward theopening 180. In the position shown in FIG. 19 the front gate 194 remainsin its original blocking position holding vial 202 in the magazine.

After the back gate has begun to rise as shown in FIG. 19, the frontgate begins to rotate in a clockwise direction toward the position shownin FIG. 20. As the front gate 194 rotates vial 202 is no longer held inthe magazine and passes out the opening 180. The back gate having fullyrotated as shown in FIG. 20, holds the next vial in the magazine frommoving until the front gate returns to its original position shown inFIG. 18. When this occurs the back gate returns to its original positionallowing the vials to roll forward and the next vial is now in theposition of vial 202.

In the preferred embodiment of the invention, the slots 192 are orientedsuch that for any size vial reasonably accommodated in the magazine, thefront and back gates are positioned so that the front gate 194 mayassume an over-center blocking position in the closed position and theback gate can move to prevent the dispense of more than one vial at atime. This ensures that with each cycle of the front and back gates onlyone vial is dispensed.

The actuating mechanism for the front and back gates is shown in FIGS.21 through 26. As shown in FIG. 21 the actuating mechanism for the gatesincludes an electrical solenoid 206. Solenoid 206 has an actuatingplunger member with a pin 208 extending traversely therefrom. Pin 208extends traversely in a first slot 210 in a first actuator plate 212which is attached to the front gate 194. Pin 208 also extends through anopening 214 in a second actuator plate 216 which is attached to backgate 196. As best shown in FIG. 22 first actuator plate 212 has atraversely extending finger 218. In the position of the front gate shownin FIGS. 21 and 22, finger 218 engages a detent 220 in the secondactuator plate 216. The purpose of detent 220 is to prevent finger 218and front gate 212 from moving in a clockwise direction whenever thesecond actuator plate 216 is in its inoperative position as shown inFIGS. 21 and 22. This prevents a person who may gain access to the frontof the magazine from being able to deflect the front gate so as to causethe vials to be removed from the magazine.

As shown in FIGS. 23 and 24 the actuation of solenoid 206 by anelectrical signal from the data terminal causes pin 208 to move secondactuator plate 216 in a clockwise direction. This causes back gate 196to move upward and detent 220 to disengage from finger 218. As a result,front gate 194 may move only after back gate 196 has risen so as toblock the dispense of further vials. Upon further movement of pin 208 bysolenoid 206 the front and back gate move to the positions shown inFIGS. 25 and 26. In these positions the front gate is rotated so as torelease vial 202 while the back gate is extended fully upward so as toprevent the discharge of the next vial in the magazine. Thereafter,discontinuance of the electrical signal to solenoid 206 returns the gatemembers to their original positions and allows the next vial to assumethe position adjacent to the opening from the magazine.

The vial dispensing mechanism of the present invention enables thecontrolled dispense of one vial at a time from the magazine in responseto an electrical signal. This assures that only the requested medicationis dispensed. The same magazine may be readily adapted to vials ofvarying diameter by adjusting the position of guide 182. The magazinealso accommodates vials of different lengths. In addition, the gatemembers are suitably secure so as to avoid tampering by persons whomight attempt to gain access to the interior of the medicine dispenser100 through the dispenser drawer 176.

The vial dispensing mechanism also assures that the requested medicalitem has been dispensed. This is assured by using signals generated bysensor 179 to minimize the risk that a dispense will be recorded whichhas not actually occurred due to a malfunction. Circuitry in thedispenser is connected to the sensor 179 and transmits signals when avial passes out of a magazine. These signals are checked to see if theyare generated when a signal to dispense to the corresponding magazine isgiven. The dispense of any item from a location and the provision ofsuch item to a patient is only recorded in the computer data store whenthe dispense is verified by the sensor associated with the magazine.Alternatively, in other embodiments a bar code reader may be installedin the dispenser and bar code applied to the vials to verify not onlythe dispense but the type of item dispensed.

Although in the above described embodiment of the medicine dispenser thegate members are shown as extending the entire width of the magazine, inother embodiments the gate members may have other configurations and maybe of different designs so as to extend only a portion of the width.Although in the preferred form of the invention the magazines extend indownward tilted relation in other embodiments they may be arranged toextend vertically. In such alternative embodiments guides may beprovided to hold the vials adjacent to plate 204. Further, the vials maybe dispensed in a vertically upward direction through incorporation ofspring loading to bias the vials upward in the magazine. A fundamentalaspect of the invention is that the gate member which corresponds to thefront gate member engages the vial in an over-center position withregard to where the vial contacts the tapered face, and the back gatemember moves in synchronized relation with the front gate member toprevent the dispense of more than one vial at a time.

The system for monitoring and dispensing medical items which includesthe hook registers, box registers, electronic lock drawer and medicinedispenser previously described may also include or be used with othertypes of devices. These may include automatic dispensing devices as wellas manual devices for which the inventory and use information can beinput as a matter of practice at a conveniently located data terminal.The system of the present invention is highly adaptable to accommodatemedical facilities of varying size. As the system of the presentinvention is also connected to a variety of computers which include datastores, a wide variety of parameters may be monitored and evaluated soas to avoid conditions of waste, fraud and abuse.

Thus the new system for dispensing and monitoring medical items of thepresent invention achieves the above stated objectives, eliminatesdifficulties encountered in the use of prior systems, solves problemsand attains the desirable results described herein.

In the foregoing description certain terms have been used for brevity,clarity and understanding. However, no unnecessary limitations are to beimplied therefrom because such terms are for descriptive purposes andare intended to be broadly construed. Moreover, the descriptions andillustrations given are by way of examples and the invention is notlimited to the exact details shown or described. In addition, anyfeature of the invention that is described in the following claims as ameans for performing a function is to be construed to encompass anymeans capable of performing the function and shall not be limited to themeans disclosed in the foregoing description or any mere functionalequivalent thereof.

Having described the features, discoveries and principles of theinvention, the manner in which it is constructed and utilized, and theadvantages and useful results obtained, the new and useful structures,devices, elements, arrangements, parts, combinations, systems,equipment, operations, methods and relationships are set forth in theappended claims.

1. A method comprising: (a) removing a first quantity of a medical itemhaving a first characteristic from a first storage location, wherein themedical item having the first characteristic is part of an inventory ofquantities of various medical items having different characteristics,wherein medical items stored in the first storage location have amedical item characteristic different from medical items stored in asecond storage location; (b) receiving inputted data representative ofremoving the first quantity from the first storage location; (c)responsive to (b), operating at least one processor in updating standingof medical item quantities associated with the inventory in carrying outreal time monitoring of the inventory, including updating a locationregarding the first quantity; (d) returning to the first storagelocation a second quantity of the first quantity removed in step (a);(e) receiving manually inputted data representative of returning thesecond quantity in step (d); (f) responsive to (e), operating the atleast one processor in updating the standing of medical item quantitiesassociated with the inventory in carrying out the real time monitoringof the inventory, including updating a location regarding the secondquantity; (g) comparing through operation of the at least one processorthe first quantity removed and the second quantity returned; (h)responsive to step (g), determining a third quantity of the firstquantity removed in step (a), wherein the first quantity equals thesecond quantity plus the third quantity, and wherein the second quantitydiffers from the third quantity; and (i) responsive to the determiningin step (h), operating the at least one processor in updating thestanding of medical item quantities associated with the inventory incarrying out the real time monitoring of the inventory, includingupdating a patient usage regarding the third quantity.
 2. The methodaccording to claim 1 wherein step (a) includes removing the firstquantity from a first storage location in a medical facility.
 3. Themethod according to claim 2 wherein step (c) includes charging a patientfor the first quantity removed.
 4. The method according to claim 3wherein step (f) includes crediting a patient for the second quantityreturned.
 5. The method according to claim 4 wherein step (i) includesbilling a patient for the third quantity used.
 6. The method accordingto claim 4 wherein step (a) includes removing plural medical itemshaving different characteristics for use in a surgical procedure,further comprising: subsequent to step (a) performing the surgicalprocedure, and wherein step (d) includes returning removed medical itemsthat were not used in the surgical procedure.
 7. The method according toclaim 1 wherein the medical item comprises a particular medicinalsubstance, and wherein step (a) includes removing a first quantity ofthe medicinal substance, wherein step (d) includes returning thesubstance to storage, and wherein the returning of the substance tostorage requires verification of user identification.
 8. A methodcomprising: (a) removing a first quantity of a medicinal substancehaving a first medical characteristic from a first storage location,wherein the medicinal substance having the first medical characteristicis part of an inventory of various medicinal substances having differentmedical characteristics, wherein the medicinal substance stored in thefirst storage location has a medical characteristic different from othermedicinal substances stored in other storage locations; (b) receivinginputted data representative of removing the first quantity from thefirst storage location; (c) responsive to (b), operating at least oneprocessor in updating standing of medicinal substances associated withthe inventory in carrying out real time monitoring of the inventory,including updating a standing of the first quantity; (d) using a secondquantity of the first quantity removed in step (a); (e) receivingmanually inputted data representative of using the second quantity instep (d); (f) responsive to (e), operating the at least one processor inupdating the standing of the medicinal substances associated with theinventory in carrying out the real time monitoring of the inventory,including updating a standing of the second quantity; (g) comparingthrough operation of the at least one processor the first quantityremoved and the second quantity used; (h) responsive to a differenceresulting from the comparing in step (g), determining a third quantityof the first quantity removed in step (a), wherein the first quantityequals the second quantity plus the third quantity, and wherein thesecond quantity differs from the third quantity; and (i) responsive to adetermining in step (h), operating the at least one processor inupdating the standing of the medicinal substances associated with theinventory in carrying out the real time monitoring of the inventory,including updating a standing of the third quantity.
 9. The methodaccording to claim 8 wherein step (a) includes manually removing thefirst quantity.
 10. The method according to claim 8 wherein step (b)includes manually inputting the data representative of removing thefirst quantity.
 11. The method according to claim 10 wherein step (b)includes manually inputting the data representative of removing thefirst quantity to a data terminal including a user interface.
 12. Themethod according to claim 1 1 wherein the terminal is operativelyconnected to at least one inventory data store, wherein step (b)includes providing data corresponding to the first quantity removed tothe at least one inventory data store via input to the terminal.
 13. Themethod according to claim 8 wherein step (d) includes using the secondquantity to replenish storage of the medicinal substance.
 14. The methodaccording to claim 13 wherein step (d) includes returning the secondquantity to storage.
 15. The method according to claim 14 wherein step(e) includes receiving data representative of returning the secondquantity.
 16. The method according to claim 8 wherein the inventoryincludes various medicinal substances stored in a pharmacy, wherein step(a) includes removing the first quantity from a first storage locationin the pharmacy.
 17. The method according to claim 16 and furthercomprising returning to the pharmacy at least one of the second quantityand the third quantity.
 18. A method comprising: (a) storing varioustypes of medications in a plurality of storage locations in a storagearea; (b) providing input via at least one computer to at least one datastore, data correlating each storage location with the type of medicalitem stored therein; (c) removing a first quantity of a first type ofmedical item from a first storage location in the storage area; (d)receiving via the at least one computer, inputted first quantity datacorresponding to removing the first quantity in step (c); (e) storingthe first quantity data received in step (d) in the at least one datastore; (f) using a second quantity of the first quantity removed in step(c); (g) receiving via the at least one computer, inputted secondquantity data corresponding to using the second quantity in step (f);(h) storing the second quantity data received in step (g) in the atleast one data store; (i) comparing through operation of the at leastone processor the first quantity data stored in step (e) and the secondquantity data stored in step (h); and (j) responsive to a differenceresulting from the comparing in step (f), providing at least one outputreflective of the difference.